五诊 金水双调，脉症相安，惟胸次时觉窒闷。冲脉气逆，亦属阴亏所致。
大生地（四钱） 生白芍（三钱） 白茯苓（三钱） 川贝母（二钱） 甘杞子（三钱） 牛膝（盐水炒三钱）
炒萸肉（一钱五分） 白芍（一钱五分） 青蛤散（四钱） 枇杷叶（去毛蜜炙四钱）
六诊膏方 吐血之后，久咳不止，投滋肾养肝保肺，咳减大半。然血去之后，肺肾皆虚，安能遽复，所以
咳嗽根蒂不除，损而未复。病情尚有出入，本难作简便之计，然道远往还非易，姑迁就拟定膏方，
不用大剂以留出入地步。
大生地（四两） 生白芍（一两五钱） 川石斛（二钱） 怀牛膝（盐水炒二两） 川贝母（二两） 白茯苓
（二两） 大熟地（三两） 肥玉竹（二两） 青蛤散（三两） 天麦冬（各一两五钱） 西洋参（一两） 炒萸
肉（一两）
当归炭（一两） 奎党参（二两） 生甘草（七钱） 生山药（二两） 冬瓜子（一两五钱） 丹皮炭（一两）
炙紫菀（一两） 阿胶（三两） 龟板胶（一两） 枇杷膏（二两）
三胶溶化收膏，晨服七八钱，午后饥时服五六钱。
金 类疟之后，湿热未清，蕴结膀胱。溲血两次，咳恋不止，旋即咯吐见红。今虽止住，咳嗽仍然未尽。脉
濡微数。良由湿热熏蒸肺胃，遂致络损血溢。拟开肺气以导湿热下行。
冬瓜子（三钱） 薏仁（三钱） 象贝母（二钱） 丝瓜络（一钱五分） 绿豆衣（二钱） 杏仁（三钱）
茯苓（三钱） 竹茹（一钱） 鲜荷叶络（三钱） 生扁豆衣（二钱） 枇杷叶（四片去毛） 活水芦根（一两）
又 咳嗽咯血之后，元气未复，阳虚肝旺，脐下漉漉鸣响，两目干涩。脉沉而弦，苔白而腻。膀胱之湿，为
风所激，所以鼓动成声。宜分利水湿，参以养肝。
生于术（一钱五分） 木猪苓（二钱） 泽泻（一钱五分） 炒白芍（一钱五分） 橘叶（三钱） 白茯苓（三钱）
野黑豆（三钱） 女贞子（三钱酒炒） 池菊花（一钱五分）
钱（左） 屡次失血，血止之后，神色淡白，动辄气逆带咳，大便溏行。脉形沉细。夫脾为统血之脏，以阳为
运，脾阳不振，则统摄无权，血遂得而妄行矣。病久不复为损，损久不复为劳，恐涉不复之虞耳。
生地炭（四钱） 牛膝炭（三钱） 炮姜炭（二分） 茜草炭（一钱） 浓杜仲（三钱） 炒于术（一
钱五分） 茯苓神（各二钱） 橘白（盐水炒一钱）
左 失血盈口而来，血止之后，腰背作酸，火时上升。脉象两关弦滑。此由中气不足，痰湿内阻，胆胃之
气不能下降。宜调中降胃，而益肝肾。
人参须（另煎冲五分） 炒麦冬（一钱五分） 川石斛（四钱） 茜草炭（一钱五分） 赭石（四钱） 桑
叶（一钱） 浓杜仲（三钱） 川断肉（三钱） 牛膝炭（三钱） 丹皮（一钱五分） 橘白（盐水炒一钱）
又 阳本上升，阴从下吸则降，阴本下降，阳从上挈则升。阳降则为蒸变生化之源，阴升则为滋养濡
润之助。今水亏于下，火升于上，其阴津之不能下吸，阳气才得上浮。滋益之品，无不粘滞，湿痰素盛之
躯，势必有碍胃纳。再以清养胃气，补益肝肾而参咸化。
人参须（另煎冲五分） 金石斛（四钱） 生扁豆（三钱） 茜草炭（一钱五分） 龟甲心（刮白炙先煎四钱）
蛤壳（四钱） 浓杜仲（三钱） 牛膝炭（三钱） 秋石（二分） 泽泻（一钱五分） 橘白（盐水炒一钱）
戴（左） 吐血成盆成碗今虽大势已定，而仍气冲咽痒。脉形沉细，舌淡苔白。胃钝纳减据述临涌之际，
四肢厥逆。良由感寒不解，与湿相合，脾阳遏郁，遂致统摄无权。还恐涌溢。
生于术（二钱） 丹皮炭（一钱五分） 茜草炭（一钱五分） 白茯苓（三钱） 炮姜炭（五分） 炙黑
草（六分） 磨三七（三分） 侧柏炭（二钱） 藕节（二枚）
尤（左） 喘咳者久。兹则肺胃络损，血来如涌。脉气口浮弦。有涌溢之虞。
炒苏子（三钱） 代赭石（四钱） 广郁金（五分磨冲） 沉香（乳汁磨三分） 杏仁泥（三钱） 侧柏
炭（二钱） 蒲黄炭（一钱） 旋复花（二钱包） 川贝母（二钱） 磨三七（三分冲） 牛膝炭（三钱） 百
草霜（一钱包）
又 昨宗缪仲醇宜降气不宜降火之说立方，气降即火降，如鼓应桴，吐血顿止。无如咳延已久，劳损
根深，虽解目前之危，仍难弥后日之虑也，得寸则寸，已为幸事矣。有仓扁其人者，尚宜就而正之。
旋复花（二钱） 代赭石（四钱） 炒苏子（三钱） 沉香（乳汁磨冲三分） 藕节（二枚） 杏仁泥（三钱）
牛膝炭（三钱） 郁金（五分磨冲） 百草霜（一钱） 茯苓（三钱） 蒲黄炭（五分）
孙（左） 失血一症，由于阴虚阳亢者多，而此症血来盈口，继发痧疹，其风温迫损肺胃，显然可见。脉细
而不耐重按。伏风未清，则新风易入。急宜微苦辛凉，以澈其根蒂。若漫投育阴补益，恐犯薛氏成劳之例不可不辨。
粉前胡（一钱五分） 象贝母（二钱） 桑叶（一钱） 丹皮炭（二钱） 薄荷（四分后入） 杏仁泥（三钱）
连翘（三钱） 桔梗（一钱） 牛蒡子（三钱） 梨肉（一两）
右 血之涌溢者已定。然咯吐犹然带红，色兼紫晦，离宫之物也。气逆较定，脉象亦略柔敛，种属转机
之兆。无如心中仍有灼热之意，咳嗽随气而来，舌红苔白而糙。此由肝升太过，肺降无权。所恐血止之
后，咳不得定，而缠入损门。拟清金平木，降气育阴。
南北沙参（各三钱） 川贝母（三钱） 炙桑皮（二钱） 沉香（乳汁磨二分） 川石斛（五钱） 紫菀
（蜜炙二钱） 肥知母（一钱五分） 郁金（五分磨冲） 地骨皮（二钱炒） 竹茹（一钱五分水炒） 赤白芍（各一
钱） 苏子（盐水炒三钱） 藕节（四枚煎）
改方去知母，加丹皮一钱五分，黑山栀二钱。
首方服犀角地黄汤案未录
又 清养肺胃，平肝降气，咳嗽稍减。然血室尚未扃，固痰中夹带粉红，热势虽退，心中尚觉热辣，纳食
之后，仍复饥 ，寐中汗出。脉细软弱，而两寸动数。体稍转动，气辄上冲，大势较前虽称平定，而阳气犹
升动不息。其上愈甚，其下愈虚，所以摄纳无权，肺降失职。非有情有质之物，不足以达其病所也。从前法进而扩充之。
龟甲心（炙先煎八钱） 代赭石（四钱 打） 牡蛎（四钱） 丹皮炭（二钱） 生赤白芍（各一钱） 真阿
胶（蛤粉拌二钱） 郁金（五分磨冲） 川贝（二钱） 炒麦冬（三钱） 枇杷叶（一两去毛） 藕汁（一杯冲）
左 失血盈碗而来。今发热不退，咳甚则血仍上涌。节令之交，深恐复溢。
丹皮炭 栝蒌皮 水炒竹茹 磨犀角尖 茜草炭 黑山栀 代赭石 磨郁金 单桃仁 藕节
又 投剂之后，症属和平，而稍涉行动，血又随气上升。恐致再溢。
磨犀尖（三分） 丹皮炭（一钱五分） 炒赤芍（一钱五分） 茜草炭（一钱五分） 郁金（磨冲五分） 三
七（二分磨冲） 生地炭（四钱） 单桃仁（打一钱五分） 炒麦冬（一钱五分） 川贝母（二钱） 藕汁（一杯冲
）南沙参（五钱）
吴（右） 向是肝胃不和，发则嗳噫胸痞。日前忽然吐血，甚至盈盂而来，今血止而至暮身热。此由肝火
上凌肺胃，血去阴伤，肝火不能敛静也。
川石斛（四钱） 丹皮炭（二钱） 茜草炭（一钱） 黑豆衣（四钱） 郁金（五分磨冲） 生扁豆衣（三钱）
水炒竹茹（一钱） 代赭石（四钱） 炒苏子（三钱） 降香（一钱） 女贞子（三钱）
左 痰饮而致咯血，中州痞满不舒，噫出腐气。脉象沉弦。此脾土为湿痰困乏，不能统血。恐损而难复。
川雅连（姜汁炒三分） 制半夏（二钱） 上广皮（一钱五分） 焦白术（一钱五分） 郁金（磨冲五分） 炮
姜（五分） 白茯苓（五钱） 炒竹茹（一钱） 炒枳实（一钱） 沉香曲（炒一钱五分）
某 肺感风邪，胃停湿热，风湿热交迫，肺胃渐损，络血外溢。血从咳中而来，咳从邪起，若不急散其邪，
必至延损。
制香附 光杏仁 橘红 生薏仁 茯苓 黑山栀 炒枳壳 前胡 丹皮炭 泽泻
左 肝肾素亏，分节之后，阳气上升，鼓击损络，络血外溢，以致吐血盈口而来。今血虽止住，而腰府作
痛。此由血去之后，肝肾愈形空乏。脉象细弱，尤属不足之征。宜益肝肾而清肺胃。
牛膝炭（三钱） 浓杜仲（三钱） 炒川断（三钱） 橘红（盐水炒一钱） 茯苓（四钱） 金毛脊（去毛炙三钱）
茜草炭（一钱五分） 炒苏子（三钱） 丹皮炭（一钱五分） 泽泻（一钱五分）
又 腰痛稍减，脉象稍振。的是吐血之后，肝肾空虚。效方再为扩充。
金毛脊（去毛炙四钱） 菟丝子（盐水炒三钱） 炒牛膝（三钱） 泽泻（一钱五分） 茯苓（三钱） 茜草炭（一
钱五分） 川断肉（盐水炒三钱） 藕节（二枚） 杜仲（三钱） 潼沙苑（盐水炒三钱） 八仙长寿丸（三钱清晨
服）
俞（左） 失血之后，火升内热，而脐下自觉有形坚满。脉数细沉。足膝欠暖。此由气虚而脾不统摄，阳气
不能转旋于下，则虚火尽越于上。将入损途。
炮姜（四分） 当归灰（二钱） 牛膝炭（三钱） 侧柏炭（三钱） 茜草炭（一钱五分） 茯苓（三钱）
炙黑草（六分） 单桃仁（打一钱五分） 丹皮炭（二钱）
又 药进之后，胃纳稍增，然脐下仍然坚满，食入脘痞。脾阳不司旋转。再从前方出入。
生地炭 炮姜炭 茜草炭 牛膝炭 当归炭 炙黑草 单桃仁 侧柏炭
又 腹偏左较舒，然结块未化。脉形濡细。太阴无旋运之权。效方出入主治。
生地炭（四钱） 炮姜炭（五分） 茜草炭（一钱五分） 南楂炭（三钱） 当归炭（二钱） 炙黑草（三分）
茯苓神（各二钱） 生熟谷芽（各二钱）
陈（左） 吐血数载不止，色淡不鲜。此湿热袭入营分，血中有湿也。血室不靖，用介宾法。
丹皮炭 炒蒌皮 赤白苓 荆芥炭 二妙丸 黑山栀 半夏曲 防风根 炒广皮
（原注）此人吐血已七八年矣，其色淡红，血少而夹湿也。
张（左） 先自木火刑金吐血，继而火郁胸中，胃口刮痛，旋至木克土而脾虚发胀，甚至吐血频年迄无
止期。良以脾土虚极，不能统摄，致谷气所生之血，渐长渐吐，所以吐血无止时，而亦并未冲溢也。兹以
温助命火，致肝火逆上，血溢盈口，由此而脾土益衰，大便作泻。六脉细涩，按之无神，苔红黄糙露底。重
地深入。勉拟仲圣柏叶汤意，合理中理阴两方，以备采择。
侧柏叶（三钱） 大熟地（五钱） 生于术（二钱） 炮姜炭（五分） 蕲艾炭（五分） 生熟草（各三分）
热童便（半茶杯乘热和药冲服）
此案能发前人所未发之旨。（文涵志）
又 土中泻木，痛已全止，便泄亦减大半，未始不为转机。无如胃仍不起，中气虚耗，不能推送，中脘之
上，咽噎之下，似有粘腻窒塞之状，动辄恶心，由此而饮食更多窒碍。再从前意参以和胃，即请正之。
野于术（枳实煎汁炒） 青盐半夏 茯苓 广皮（盐水炒） 台参须（另煎冲一钱） 金石斛
杭白芍（防风煎汁炒） 薏仁 竹茹（盐水炒） 香稻根须（五钱）
左 温邪两候，热迫阳明，屡投辛甘寒合方，大热甫定。而素体木旺阴虚，昨晚偶触怒火，遂致肝火逆
冲，肺胃络损，今晨呕吐鲜血，竟有盈碗之多。胃与大肠，两相联续，所以呕吐之后，继以便血。今血虽暂
定，而心中漾漾，尚有欲涌之势，寐则汗出。脉形左大，寸浮关弦尺涩，右部濡弱，气口带搏，舌干无津。皆
由木火久郁，触之即发，以致急速之性，损络动血，阳浮阴弱，肾水不能滋涵，封藏因而不固，所以寐则
汗出。中气下根于肾，肾水愈亏，则木火愈旺，而中气愈弱，所以胃呆少纳。病中变病，花甲之年，何堪经
此一波再折也。勉与叔涛先生共议养肝滋肾，兼益水之上源，略参凉营收固。即请崇山先生裁夺。
大生地（四钱） 阿胶珠（三钱） 天麦冬（各二钱） 鲜竹茹（一钱五分） 磨犀尖（三分） 代赭石（五钱）
生牡蛎（八钱） 生白芍（二钱） 大元参（三钱） 丹皮炭（二钱） 浮麦（一两五钱） 藕汁（一酒杯）
二诊 养肝滋肾，木得水涵，气火之逆冲者已平，阳气之泄越者渐固，血未复来，汗出大减。舌边尖转
润，然中心仍然干燥。胃为阳土，脏阴皆虚，胃液安得不耗，有气无液，胃气安得调和，所以胃纳仍然不
旺，实与中气不振者迥然不同。脉左弦大，右部大而濡软。肾水肺津，肝阴胃液，一齐耗损，然胃府以通
为用。再拟滋水养液，而择其不滞者投之。即请叔涛先生商进。
大生地（五钱） 天麦冬（各二钱） 生甘草（四分） 茯苓神（各一钱五分） 丹皮炭（一钱五分） 川贝母（
Visit 5: Metal and Water are simultaneously regulated; the pulse and symptoms are in harmony, except for occasional chest stuffiness. The rebellious Qi of the Chong vessel is also caused by Yin deficiency.
Shu Di Huang (Rehmanniae Radix Preparata) (4 qian), Sheng Bai Shao (Paeoniae Radix Alba) (3 qian), Bai Fu Ling (Poria) (3 qian), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) (2 qian), Gan Qi Zi (Lycii Fructus) (3 qian), Niu Xi (Achyranthis Bidentatae Radix) (stir-fried with salt water, 3 qian), Chao Yu Rou (Corni Fructus) (1.5 qian), Bai Shao (Paeoniae Radix Alba) (1.5 qian), Qing Ge San (Green Clam Powder) (4 qian), Pi Pa Ye (Loquat Leaf) (deprived of hairs, honey-fried, 4 qian).
Visit 6: Paste Prescription. After hematemesis, chronic cough persists. Treatment with nourishing Kidney, nurturing Liver, and protecting Lung has reduced the cough by more than half. However, after blood loss, both Lung and Kidney are deficient; how can they recover quickly? Thus, the root of the cough remains, and the body is damaged but not restored. The condition varies, making simple treatment difficult. Given the long distance and difficulty of travel, a paste prescription is tentatively formulated without large doses to allow room for adjustment.
Da Sheng Di (Rehmanniae Radix) (4 liang), Sheng Bai Shao (Paeoniae Radix Alba) (1.5 liang 5 qian), Chuan Shi Hu (Dendrobii Caulis) (2 qian), Huai Niu Xi (Achyranthis Bidentatae Radix) (stir-fried with salt water, 2 liang), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) (2 liang), Bai Fu Ling (Poria) (2 liang), Da Shu Di (Rehmanniae Radix Preparata) (3 liang), Fei Yu Zhu (Polygonati Odorati Rhizoma) (2 liang), Qing Ge San (Green Clam Powder) (3 liang), Tian Dong (Ophiopogonis Radix) and Mai Dong (Scrophulariae Radix) (each 1.5 liang), Xi Yang Shen (American Ginseng) (1 liang), Chao Yu Rou (Corni Fructus) (1 liang).
Dang Gui Tan (Angelicae Sinensis Radix Carbonized) (1 liang), Kui Dang Shen (Codonopsis Radix) (2 liang), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma) (7 qian), Sheng Shan Yao (Dioscoreae Rhizoma) (2 liang), Dong Gua Zi (Benincasae Semen) (1.5 liang), Dan Pi Tan (Moutan Cortex Carbonized) (1 liang), Zhi Zi Wan (Astaghmi Radix) (honey-fried, 1 liang), E Jiao (Colla Corii Asini) (3 liang), Gui Ban Jiao (Colla Testudinis) (1 liang), Pi Pa Gao (Loquat Paste) (2 liang).
The three jiaos (gelatins) are dissolved to form the paste. Take 7-8 qian in the morning, and 5-6 qian when hungry in the afternoon.
Patient Jin: After a malaria-like illness, damp-heat remains unclarified and accumulates in the Bladder. Hematuria occurred twice, followed by persistent cough and subsequent hemoptysis. Although it has stopped now, the cough is not fully resolved. The pulse is soggy and slightly rapid. This is due to damp-heat steaming the Lung and Stomach, damaging collaterals and causing blood extravasation. The plan is to open Lung Qi to guide damp-heat downward.
Dong Gua Zi (Benincasae Semen) (3 qian), Yi Ren (Coicis Semen) (3 qian), Xiang Bei Mu (Fritillariae Thunbergii Bulbus) (2 qian), Si Gua Luo (Luffae Fructus Retinervia) (1.5 qian), Lv Dou Yi (Phaseoli Radiati Pericarpium) (2 qian), Xing Ren (Armeniacae Semen Amarum) (3 qian), Fu Ling (Poria) (3 qian), Zhu Ru (Bambusae Caulis in Taeniam) (1 qian), Xian He Ye Luo (Lotus Leaf Veins) (3 qian), Sheng Bian Dou Yi (Dolichoris Semen Pericarpium) (2 qian), Pi Pa Ye (Loquat Leaf) (4 pieces, deprived of hairs), Huo Lu Gen (Phragmitis Rhizoma) (1 liang).
Another visit: After cough and hemoptysis, Yuan Qi has not recovered. Yang deficiency and hyperactive Liver cause gurgling sounds below the umbilicus and dry eyes. The pulse is deep and wiry; the coating is white and greasy. Dampness in the Bladder is agitated by Wind, creating sound. Treatment should separate and drain dampness, combined with nourishing the Liver.
Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma) (1.5 qian), Mu Zhu Ling (Polyporus) (2 qian), Ze Xie (Alismatis Rhizoma) (1.5 qian), Chao Bai Shao (Paeoniae Radix Alba) (1.5 qian), Ju Ye (Citri Reticulatae Folium) (3 qian), Bai Fu Ling (Poria) (3 qian), Ye Hei Dou (Sojae Helvolae Semen) (3 qian), Nu Zhen Zi (Ligustri Lucidi Fructus) (wine-fried, 3 qian), Chi Ju Hua (Chrysanthemi Flos) (1.5 qian).
Patient Qian (Left): Recurrent blood loss. After bleeding stops, the complexion is pale; movement triggers rebellious Qi with cough, and stool is loose. The pulse is deep and fine. The Spleen is the organ that controls blood, relying on Yang for transportation. If Spleen Yang is weak, control is lost, and blood flows recklessly. Chronic illness without recovery is termed "Sun" (Damage); prolonged damage without recovery is termed "Lao" (Consumption). There is fear of irrecoverable decline.
Sheng Di Tan (Rehmanniae Radix Carbonized) (4 qian), Niu Xi Tan (Achyranthis Bidentatae Radix Carbonized) (3 qian), Pao Jiang (Zingiberis Rhizoma Preparatum) (2 fen), Qian Cao Tan (Rubiae Cordifoliae Radix Carbonized) (1 qian), Nong Du Zhong (Eucommiae Cortex) (3 qian), Chao Bai Zhu (Atractylodis Macrocephalae Rhizoma) (1.5 qian), Fu Ling Shen (Poria cum Radice) (each 2 qian), Ju Bai (Citri Reticulatae Pericarpium) (salt-water fried, 1 qian).
Left Visit: Massive hematemesis. After bleeding stops, the lower back and waist ache, and fire rises frequently. The pulse at both Guan positions is wiry and slippery. This is due to insufficient Middle Qi, internal obstruction by phlegm-dampness, and failure of Gallbladder and Stomach Qi to descend. Treatment should regulate the Middle, descend Stomach Qi, and benefit Liver and Kidney.
Ren Shen Xu (Ginseng Radix Et Rhizoma Filiformis) (decocted separately, 5 fen), Chao Mai Dong (Scrophulariae Radix) (1.5 qian), Chuan Shi Hu (Dendrobii Caulis) (4 qian), Qian Cao Tan (Rubiae Cordifoliae Radix Carbonized) (1.5 qian), Zhe Shi (Hematitum) (4 qian), Sang Ye (Mori Folium) (1 qian), Nong Du Zhong (Eucommiae Cortex) (3 qian), Chuan Duan Rou (Dipsaci Radix) (3 qian), Niu Xi Tan (Achyranthis Bidentatae Radix Carbonized) (3 qian), Dan Pi (Moutan Cortex) (1.5 qian), Ju Bai (Citri Reticulatae Pericarpium) (salt-water fried, 1 qian).
Another visit: Yang naturally tends to rise; Yin draws it down from below to descend. Yin naturally tends to descend; Yang pulls it up from above to rise. Descending Yang is the source of transformation and generation; ascending Yin provides nourishment and moistening. Now, Water is deficient below, Fire rises above. Because Yin-Jin cannot be drawn down, Yang floats upward. Nourishing substances are sticky and cloying; for a constitution with abundant damp-phlegm, they will hinder Stomach intake. Use clear-nourishing methods to benefit Stomach Qi, tonify Liver and Kidney, and incorporate salty flavors to soften hardness.
Ren Shen Xu (Ginseng Radix Et Rhizoma Filiformis) (decocted separately, 5 fen), Jin Shi Hu (Dendrobii Caulis) (4 qian), Sheng Bian Dou (Dolichoris Semen) (3 qian), Qian Cao Tan (Rubiae Cordifoliae Radix Carbonized) (1.5 qian), Gui Jia Xin (Testudinis Carapax Et Plastrum - Heart) (scraped, fried, decocted first, 4 qian), Ge Ke (Cyclinae Concha) (4 qian), Nong Du Zhong (Eucommiae Cortex) (3 qian), Niu Xi Tan (Achyranthis Bidentatae Radix Carbonized) (3 qian), Qiu Shi (Urinalis Calculus) (2 fen), Ze Xie (Alismatis Rhizoma) (1.5 qian), Ju Bai (Citri Reticulatae Pericarpium) (salt-water fried, 1 qian).
Patient Dai (Left): Hematemesis filling basins and bowls. Although the major trend has stabilized, there is still Qi rushing to the throat causing itching. The pulse is deep and fine; the tongue is pale with a white coating. Stomach Qi is dull, and appetite is reduced. It is reported that during the rush, limbs were cold. This is due to unresolved Cold combining with Dampness, suppressing Spleen Yang, leading to loss of control over blood. Fear of further hemorrhage.
Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma) (2 qian), Dan Pi Tan (Moutan Cortex Carbonized) (1.5 qian), Qian Cao Tan (Rubiae Cordifoliae Radix Carbonized) (1.5 qian), Bai Fu Ling (Poria) (3 qian), Pao Jiang (Zingiberis Rhizoma Preparatum) (5 fen), Zhi Hei Cao (Glycyrrhizae Radix et Rhizoma Preparated Black) (6 fen), Mo San Qi (Notoginseng Radix) (3 fen), Ce Bai Tan (Platycladi Cacumen Carbonized) (2 qian), Ou Jie (Nelumbinis Nelumbo) (2 pieces).
Patient You (Left): Chronic wheezing and cough. Now, Lung and Stomach collaterals are damaged, and blood comes like a surge. The pulse at the Kou position is floating and wiry. There is risk of hemorrhage.
Chao Su Zi (Perillae Fructus) (3 qian), Dai Zhe Shi (Hematitum) (4 qian), Guang Yu Jin (Curcumae Radix) (5 fen, ground and taken with liquid), Chen Xiang (Aquilariae Lignum Resinatum) (ground with milk, 3 fen), Xing Ren Ni (Armeniacae Semen Amarum Paste) (3 qian), Ce Bai Tan (Platycladi Cacumen Carbonized) (2 qian), Pu Huang Tan (Typhae Pollen Carbonized) (1 qian), Xuan Fu Hua (Inulae Flos) (wrapped, 2 qian), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) (2 qian), Mo San Qi (Notoginseng Radix) (3 fen, mixed), Niu Xi Tan (Achyranthis Bidentatae Radix Carbonized) (3 qian), Bai Cao Shuang (Carbonized Grass Ash) (wrapped, 1 qian).
Another visit: Yesterday, following Miu Zhongchun's principle of "descending Qi rather than descending Fire," the formula was made. When Qi descends, Fire descends, like a drum responding to a beat, and hematemesis stopped instantly. Unfortunately, the cough has persisted for a long time, and the root of consumption is deep. Although immediate danger is resolved, future worries remain. Every inch gained is fortunate. One should consult experts like Cang Gong or Bian Que.
Xuan Fu Hua (Inulae Flos) (2 qian), Dai Zhe Shi (Hematitum) (4 qian), Chao Su Zi (Perillae Fructus) (3 qian), Chen Xiang (Aquilariae Lignum Resinatum) (ground with milk, 3 fen), Ou Jie (Nelumbinis Nelumbo) (2 pieces), Xing Ren Ni (Armeniacae Semen Amarum Paste) (3 qian), Niu Xi Tan (Achyranthis Bidentatae Radix Carbonized) (3 qian), Yu Jin (Curcumae Radix) (5 fen, ground and mixed), Bai Cao Shuang (Carbonized Grass Ash) (1 qian), Fu Ling (Poria) (3 qian), Pu Huang Tan (Typhae Pollen Carbonized) (5 fen).
Patient Sun (Left): Blood loss is often due to Yin deficiency and Yang hyperactivity. In this case, blood fills the mouth, followed by sand-rash. Wind-Warmth damages Lung and Stomach, which is evident. The pulse is fine and cannot withstand heavy pressure. Unresolved latent Wind makes new Wind easy to enter. Urgently use slightly bitter, acrid, and cool herbs to clear the root. Blindly using Yin-nourishing tonics may lead to the "Lao" (consumption) pattern described by Xue. This must be distinguished.
Fen Qian Hu (Peucedani Radix) (1.5 qian), Xiang Bei Mu (Fritillariae Thunbergii Bulbus) (2 qian), Sang Ye (Mori Folium) (1 qian), Dan Pi Tan (Moutan Cortex Carbonized) (2 qian), Bo He (Menthae Haplocalycis Herba) (4 fen, added later), Xing Ren Ni (Armeniacae Semen Amarum Paste) (3 qian), Lian Qiao (Forsythiae Fructus) (3 qian), Jie Geng (Platycodonis Radix) (1 qian), Niu Bang Zi (Arctii Fructus) (3 qian), Li Rou (Pyrus Sinkiangensis Flesh) (1 liang).
Right Visit: The surge of blood has stabilized. However, expectoration still contains red, purple-dark blood, which is blood outside the vessels. Qi rebellion has settled, and the pulse has become slightly soft and restrained, indicating a turning point. Unfortunately, there is still burning heat in the heart, and cough accompanies Qi movement. The tongue is red with a white, rough coating. This is due to excessive Liver rising and powerless Lung descending. Fear that after bleeding stops, the cough will not settle and will enter the realm of consumption. Plan to clear Metal (Lung) and calm Wood (Liver), descend Qi, and nourish Yin.
Nan Sha Shen (Adenophorae Radix) and Bei Sha Shen (Glehniae Radix) (each 3 qian), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) (3 qian), Zhi Sang Pi (Mori Cortex) (2 qian), Chen Xiang (Aquilariae Lignum Resinatum) (ground with milk, 2 fen), Chuan Shi Hu (Dendrobii Caulis) (5 qian), Zi Wan (Astagmi Radix) (honey-fried, 2 qian), Fei Zhi Mu (Anemarrhenae Rhizoma) (1.5 qian), Yu Jin (Curcumae Radix) (5 fen, ground and mixed), Di Gu Pi (Lycii Cortex) (stir-fried, 2 qian), Zhu Ru (Bambusae Caulis in Taeniam) (water-fried, 1.5 qian), Chi Shao (Paeoniae Radix Rubra) and Bai Shao (Paeoniae Radix Alba) (each 1 qian), Su Zi (Perillae Fructus) (salt-water fried, 3 qian), Ou Jie (Nelumbinis Nelumbo) (4 pieces, decocted).
Modified prescription: Remove Zhi Mu, add Dan Pi (1.5 qian) and Hei Shan Zhi (Gardeniae Fructus Carbonized) (2 qian).
First prescription used Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction); case not recorded.
Another visit: Clearing and nourishing Lung and Stomach, calming Liver and descending Qi, the cough has slightly decreased. However, the "Blood Chamber" is not yet closed; sputum still contains pink traces. Although heat has subsided, there is still burning heat in the heart. After eating, hunger returns, and sweating occurs during sleep. The pulse is fine and weak, with rapid movement at both Cun positions. Slight movement causes Qi to rush upward. Although the major trend is stable compared to before, Yang Qi continues to rise and move. The higher it rises, the weaker the lower becomes, leading to loss of grasping power and failure of Lung descent. Only substantial, organic substances can reach the disease site. Expand upon the previous method.
Gui Jia Xin (Testudinis Carapax Et Plastrum - Heart) (fried, decocted first, 8 qian), Dai Zhe Shi (Hematitum) (4 qian, crushed), Mu Li (Ostreae Concha) (4 qian), Dan Pi Tan (Moutan Cortex Carbonized) (2 qian), Sheng Chi Bai Shao (Paeoniae Radix Rubra and Alba) (each 1 qian), Zhen E Jiao (Colla Corii Asini) (mixed with Ge Fen, 2 qian), Yu Jin (Curcumae Radix) (5 fen, ground and mixed), Chuan Bei (Fritillariae Cirrhosae Bulbus) (2 qian), Chao Mai Dong (Scrophulariae Radix) (3 qian), Pi Pa Ye (Loquat Leaf) (1 liang, deprived of hairs), Ou Zhi (Nelumbinis Nelumbo Juice) (1 cup, mixed).
Left Visit: Massive hematemesis filling a bowl. Fever persists; severe cough causes blood to surge again. At the change of seasons, fear of recurrence.
Dan Pi Tan (Moutan Cortex Carbonized), Gua Lou Pi (Trichosanthis Pericarpium), Zhu Ru (Bambusae Caulis in Taeniam) (water-fried), Xi Jiao Jian (Rhinocerotis Cornu) (ground), Qian Cao Tan (Rubiae Cordifoliae Radix Carbonized), Hei Shan Zhi (Gardeniae Fructus Carbonized), Dai Zhe Shi (Hematitum), Yu Jin (Curcumae Radix) (ground), Dan Tao Ren (Persicae Semen) (single), Ou Jie (Nelumbinis Nelumbo).
Another visit: After medication, symptoms are peaceful, but slight movement causes blood to rise with Qi. Fear of re-hemorrhage.
Xi Jiao Jian (Rhinocerotis Cornu) (3 fen, ground), Dan Pi Tan (Moutan Cortex Carbonized) (1.5 qian), Chao Chi Shao (Paeoniae Radix Rubra) (1.5 qian), Qian Cao Tan (Rubiae Cordifoliae Radix Carbonized) (1.5 qian), Yu Jin (Curcumae Radix) (5 fen, ground and mixed), San Qi (Notoginseng Radix) (2 fen, ground and mixed), Sheng Di Tan (Rehmanniae Radix Carbonized) (4 qian), Dan Tao Ren (Persicae Semen) (crushed, 1.5 qian), Chao Mai Dong (Scrophulariae Radix) (1.5 qian), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) (2 qian), Ou Zhi (Nelumbinis Nelumbo Juice) (1 cup, mixed), Nan Sha Shen (Adenophorae Radix) (5 qian).
Patient Wu (Right): Previously, Liver and Stomach were disharmonious, causing belching and chest fullness. Suddenly, hematemesis occurred, filling a basin. Now, after bleeding stops, fever arises at dusk. This is due to Liver Fire harassing Lung and Stomach; blood loss injures Yin, and Liver Fire cannot quiet down.
Chuan Shi Hu (Dendrobii Caulis) (4 qian), Dan Pi Tan (Moutan Cortex Carbonized) (2 qian), Qian Cao Tan (Rubiae Cordifoliae Radix Carbonized) (1 qian), Hei Dou Yi (Sojae Helvolae Semen Pericarpium) (4 qian), Yu Jin (Curcumae Radix) (5 fen, ground and mixed), Sheng Bian Dou Yi (Dolichoris Semen Pericarpium) (3 qian), Zhu Ru (Bambusae Caulis in Taeniam) (water-fried, 1 qian), Dai Zhe Shi (Hematitum) (4 qian), Chao Su Zi (Perillae Fructus) (3 qian), Jiang Xiang (Daemonorops Spatha) (1 qian), Nu Zhen Zi (Ligustri Lucidi Fructus) (3 qian).
Left Visit: Phlegm-fluid retention causes hemoptysis. Epigastric fullness and discomfort, belching foul air. Pulse is deep and wiry. Spleen Earth is troubled by damp-phlegm and cannot control blood. Fear of damage and difficulty in recovery.
Chuan Ya Lian (Coptidis Rhizoma) (fried with Ginger Juice, 3 fen), Zhi Ban Xia (Pinelliae Tuber Preparatum) (2 qian), Shang Guang Pi (Citri Reticulatae Pericarpium) (1.5 qian), Jiao Bai Zhu (Atractylodis Macrocephalae Rhizoma Charred) (1.5 qian), Yu Jin (Curcumae Radix) (5 fen, ground and mixed), Pao Jiang (Zingiberis Rhizoma Preparatum) (5 fen), Bai Fu Ling (Poria) (5 qian), Chao Zhu Ru (Bambusae Caulis in Taeniam) (1 qian), Chao Zhi Shi (Aurantii Fructus Immaturus) (1 qian), Chen Xiang Qu (Aquilariae Lignum Resinatum Fermented Product) (fried, 1.5 qian).
Certain Patient: Lung affected by Wind pathogen; Stomach retains damp-heat. Wind, Damp, and Heat press together, gradually damaging Lung and Stomach, causing collateral blood to extravasate. Blood comes from cough; cough originates from pathogen. If pathogen is not dispersed urgently, damage will prolong.
Zhi Xiang Fu (Cyperi Rhizoma Preparatum), Guang Xing Ren (Armeniacae Semen Amarum), Ju Hong (Citri Reticulatae Pericarpium), Sheng Yi Ren (Coicis Semen), Fu Ling (Poria), Hei Shan Zhi (Gardeniae Fructus Carbonized), Chao Zhi Qiao (Aurantii Fructus Immaturus Fried), Qian Hu (Peucedani Radix), Dan Pi Tan (Moutan Cortex Carbonized), Ze Xie (Alismatis Rhizoma).
Left Visit: Liver and Kidney have been deficient since youth. After the solar term, Yang Qi rises, striking and damaging collaterals, causing collateral blood to extravasate, resulting in massive hematemesis. Although bleeding has stopped, the lower back aches. This is because blood loss has further depleted Liver and Kidney. The pulse is fine and weak, indicating insufficiency. Benefit Liver and Kidney, clear Lung and Stomach.
Niu Xi Tan (Achyranthis Bidentatae Radix Carbonized) (3 qian), Nong Du Zhong (Eucommiae Cortex) (3 qian), Chuan Duan (Dipsaci Radix) (3 qian), Ju Hong (Citri Reticulatae Pericarpium) (salt-water fried, 1 qian), Fu Ling (Poria) (4 qian), Jin Mao Ji (Cibotii Rhizoma) (deprived of hairs, fried, 3 qian), Qian Cao Tan (Rubiae Cordifoliae Radix Carbonized) (1.5 qian), Chao Su Zi (Perillae Fructus) (3 qian), Dan Pi Tan (Moutan Cortex Carbonized) (1.5 qian), Ze Xie (Alismatis Rhizoma) (1.5 qian).
Another visit: Lower back pain slightly reduced; pulse slightly strengthened. Indeed, after hematemesis, Liver and Kidney are empty. Effective formula expanded.
Jin Mao Ji (Cibotii Rhizoma) (deprived of hairs, fried, 4 qian), Tu Si Zi (Cuscutae Semen) (salt-water fried, 3 qian), Chao Niu Xi (Achyranthis Bidentatae Radix) (3 qian), Ze Xie (Alismatis Rhizoma) (1.5 qian), Fu Ling (Poria) (3 qian), Qian Cao Tan (Rubiae Cordifoliae Radix Carbonized) (1.5 qian), Chuan Duan Rou (Dipsaci Radix) (salt-water fried, 3 qian), Ou Jie (Nelumbinis Nelumbo) (2 pieces), Du Zhong (Eucommiae Cortex) (3 qian), Tong Sha Yuan (Tussilaginis Semen) (salt-water fried, 3 qian), Ba Xian Chang Shou Wan (Eight Immortals Longevity Pill) (3 qian, taken in the morning).
Patient Yu (Left): After blood loss, Fire rises causing internal heat, and a hard fullness is felt below the umbilicus. Pulse is rapid, fine, and deep. Feet and knees are warm. This is due to Qi deficiency and Spleen failing to control; Yang Qi cannot rotate downward, so deficient Fire escapes upward. Approaching the path of consumption.
Pao Jiang (Zingiberis Rhizoma Preparatum) (4 fen), Dang Gui Hui (Angelicae Sinensis Radix Ash) (2 qian), Niu Xi Tan (Achyranthis Bidentatae Radix Carbonized) (3 qian), Ce Bai Tan (Platycladi Cacumen Carbonized) (3 qian), Qian Cao Tan (Rubiae Cordifoliae Radix Carbonized) (1.5 qian), Fu Ling (Poria) (3 qian), Zhi Hei Cao (Glycyrrhizae Radix et Rhizoma Preparated Black) (6 fen), Dan Tao Ren (Persicae Semen) (crushed, 1.5 qian), Dan Pi Tan (Moutan Cortex Carbonized) (2 qian).
Another visit: After taking medicine, appetite slightly increases, but hardness below the umbilicus persists, and epigastric fullness occurs after eating. Spleen Yang does not rotate. Adjust the previous formula.
Sheng Di Tan (Rehmanniae Radix Carbonized), Pao Jiang Tan (Zingiberis Rhizoma Preparatum Carbonized), Qian Cao Tan (Rubiae Cordifoliae Radix Carbonized), Niu Xi Tan (Achyranthis Bidentatae Radix Carbonized), Dang Gui Tan (Angelicae Sinensis Radix Carbonized), Zhi Hei Cao (Glycyrrhizae Radix et Rhizoma Preparated Black), Dan Tao Ren (Persicae Semen), Ce Bai Tan (Platycladi Cacumen Carbonized).
Another visit: Left abdomen is more comfortable, but the mass has not dissolved. Pulse is soggy and fine. Tai Yin lacks rotational power. Adjust effective formula for treatment.
Sheng Di Tan (Rehmanniae Radix Carbonized) (4 qian), Pao Jiang (Zingiberis Rhizoma Preparatum) (5 fen), Qian Cao Tan (Rubiae Cordifoliae Radix Carbonized) (1.5 qian), Nan Zha Tan (Crataegi Fructus Carbonized) (3 qian), Dang Gui Tan (Angelicae Sinensis Radix Carbonized) (2 qian), Zhi Hei Cao (Glycyrrhizae Radix et Rhizoma Preparated Black) (3 fen), Fu Ling Shen (Poria cum Radice) (each 2 qian), Sheng Shu Gu Ya (Hordei Fructus Germinatus) (each 2 qian).
Patient Chen (Left): Hematemesis for years, color pale and dull. This is damp-heat invading the Ying level; blood contains dampness. The Blood Chamber is unstable; use Mediator Method.
Dan Pi Tan (Moutan Cortex Carbonized), Chao Lou Pi (Trichosanthis Pericarpium), Chi Bai Ling (Poria Rubra and Alba), Jing Jie Tan (Schizonepetae Spica Carbonized), Er Miao Wan (Two Marvels Pill), Hei Shan Zhi (Gardeniae Fructus Carbonized), Ban Xia Qu (Pinelliae Tuber Fermented Product), Fang Feng Gen (Saposhnikoviae Radix), Chao Guang Pi (Citri Reticulatae Pericarpium).
(Original Note): This patient has had hematemesis for 7-8 years. The color is pale red, with little blood and mixed dampness.
Patient Zhang (Left): Initially, Wood-Fire insulted Metal causing hematemesis. Then Fire stagnated in the chest, scraping pain in the stomach opening. Subsequently, Wood overacted on Earth, causing Spleen deficiency and bloating. Even frequent hematemesis for years without end. Truly, Spleen Earth is extremely deficient, unable to control, causing blood generated from grain Qi to grow and vomit gradually. Thus, hematemesis has no end time, nor does it surge violently. Now, warming and assisting Ming Men Fire caused Liver Fire to rebel upward, blood overflowing the mouth. Consequently, Spleen Earth declines further, and diarrhea occurs. Six pulses are fine and choppy, lacking spirit upon pressure; coating is red-yellow, rough, exposing the base. Deep investigation required. Tentatively propose the intent of Zhong Jing's Bo Ye Tang (Cacumen Platycladi Decoction), combined with Li Zhong Tang (Regulate the Middle Decoction) and Li Yin Tang (Regulate Yin Decoction), for selection.
Ce Bai Ye (Cacumen Platycladi) (3 qian), Da Shu Di (Rehmanniae Radix Preparata) (5 qian), Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma) (2 qian), Pao Jiang Tan (Zingiberis Rhizoma Preparatum Carbonized) (5 fen), Qi Ai Tan (Artemisiae Argyi Folium Carbonized) (5 fen), Sheng Shu Cao (Glycyrrhizae Radix et Rhizoma) (each 3 fen), Re Tong Bian (Hot Urine of Child) (half teacup, mix with medicine while hot and take).
This case reveals insights not previously expressed by predecessors. (Comment by Wen Hanzhi)
Another visit: Draining Wood from Earth, pain has completely stopped, and diarrhea has reduced by more than half, which is a turning point. Unfortunately, Stomach still fails to function, Middle Qi is exhausted and cannot transport. Above the Zhong Wan, below the throat, there seems to be sticky obstruction. Nausea occurs easily, hindering diet further. Again, follow previous intent, combine with harmonizing Stomach, please correct.
Ye Bai Zhu (Atractylodis Macrocephalae Rhizoma) (fried with Zhi Shi decoction), Qing Yan Ban Xia (Pinelliae Tuber Preparated with Salt), Fu Ling (Poria), Guang Pi (Citri Reticulatae Pericarpium) (salt-water fried), Tai Shen Xu (Ginseng Radix Et Rhizoma Filiformis) (decocted separately, 1 qian), Jin Shi Hu (Dendrobii Caulis), Hang Bai Shao (Paeoniae Radix Alba) (fried with Fang Feng decoction), Yi Ren (Coicis Semen), Zhu Ru (Bambusae Caulis in Taeniam) (salt-water fried), Xiang Dao Gen Xu (Oryzae Sativa Rootlet) (5 qian).
Left Visit: Warm pathogen for two periods, Heat forces Yangming. Repeatedly administering Acrid-Sweet-Cold combination formulas, major heat just settled. But constitution is Wood-hyperactive and Yin-deficient. Last night, touched by anger, Liver Fire rebelled upward, damaging Lung and Stomach collaterals. This morning, vomiting fresh blood, filling a bowl. Stomach and Large Intestine are continuous, so after vomiting, bloody stool followed. Although blood has temporarily stabilized, there is surging sensation in the heart, and sweating during sleep. Pulse left is large; Cun floating, Guan wiry, Chi choppy. Right is soggy and weak; Qi Kou has pulsation. Tongue is dry without fluid. All due to long-term stagnation of Wood-Fire, triggered easily, causing rapid nature, damaging collaterals and moving blood. Yang floats, Yin is weak; Kidney Water cannot nourish, sealing and storing become insecure, hence sweating during sleep. Middle Qi roots in Kidney; the more Kidney Water declines, the stronger Wood-Fire becomes, and the weaker Middle Qi gets, hence poor appetite. Disease changing into complication, at age sixty, how can one endure another setback? Tentatively discuss with Mr. Shutao: nourish Liver, tonify Kidney, benefit Upper Source of Water, slightly incorporate cooling astringents to consolidate. Please let Mr. Chongshan decide.
Da Sheng Di (Rehmanniae Radix) (4 qian), E Jiao Zhu (Colla Corii Asini Pearl) (3 qian), Tian Mai Dong (Ophiopogonis Radix and Scrophulariae Radix) (each 2 qian), Xian Zhu Ru (Bambusae Caulis in Taeniam) (1.5 qian), Xi Jiao Jian (Rhinocerotis Cornu) (3 fen, ground), Dai Zhe Shi (Hematitum) (5 qian), Sheng Mu Li (Ostreae Concha) (8 qian), Sheng Bai Shao (Paeoniae Radix Alba) (2 qian), Da Yuan Shen (Scrophulariae Radix) (3 qian), Dan Pi Tan (Moutan Cortex Carbonized) (2 qian), Fu Mai (Triticum Levis Fructus) (1.5 liang), Ou Zhi (Nelumbinis Nelumbo Juice) (1 wine glass).
Visit 2: Nourishing Liver and Kidney, Wood receives Water nourishment; rebellious Qi and Fire have flattened, leaking Yang is gradually secured. Blood has not returned, sweating greatly reduced. Tongue edges and tip have turned moist, but center remains dry. Stomach is Yang Earth, all Zang Yins are deficient; how can Stomach Fluid not be consumed? Having Qi but no Fluid, how can Stomach Qi harmonize? Hence appetite remains poor, distinctly different from Middle Qi weakness. Pulse left is wiry and large; right is large, soggy, and soft. Kidney Water, Lung Jin, Liver Yin, and Stomach Fluid are all depleted. However, Stomach House uses unobstructed flow as its function. Again, plan to tonify Water and nourish Fluid, selecting those that do not stagnate. Please discuss with Mr. Shutao.
Da Sheng Di (Rehmanniae Radix) (5 qian), Tian Mai Dong (Ophiopogonis Radix and Scrophulariae Radix) (each 2 qian), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma) (4 fen), Fu Ling Shen (Poria cum Radice) (each 1.5 qian), Dan Pi Tan (Moutan Cortex Carbonized) (1.5 qian), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) (